Table 3 Case study examining accommodation environment and mental health of service users

Some service users faced challenges with their mental health. They found it difficult to stay indoors, especially when sufficient support for mental health and substance use was unavailable. While this was not universal, some people reported feeling “isolated”. Constant fights broke out in their accommodations and many people were eventually evicted. Service providers also reported having to buy alcohol to reduce withdrawal symptoms in the service users with alcohol dependence to offer harm reduction strategies

“The charity had a no drinking rule… you've just put a bunch of alcoholics in to a hotel and then tell them not to drink… It's seriously not understanding addiction…I'd say in the 48 h I was there at least a third that were taken in were back out on the streets.” (SU6, London)

Service providers reported that due to the lack of resources at the time of the pandemic, mental health providers were sometimes redeployed, leaving an unmet need for service users

“…At a time when the entire population’s mental health was struggling because of social isolation and everything, it was a very scary time and they were taken out of the homeless sector and they were remobilised into, redeployed into a different job [due to low priority]…” (SP5, London)

This was echoed by those who were accommodated who felt the changes to service provision left gaps: “She was as helpful as she could be within her remit… She wanted me to go to council offices, but I didn’t want to go to the council office to explain why my mental health was going down. I wanted her to come to me, but she wouldn’t. No one came.” (SU7, London)

Furthermore, while pharmacies continued to be open during the pandemic, travelling to them daily for collecting opioid agonist treatment was often a challenge for service users. As a result, in some cases, pharmacies would have to dispense more than one day’s script at a time, which in some cases was not viewed positively: “When I first got out, they were having to give people fourteen days [of methadone] to take away with them. Obviously, if people are normally going once a day to pick it up, getting fourteen days’ worth of methadone to take away with them people were lapsing…it was just making things worse.” (SU3, North East)

On the other hand, some service users, especially people who use alcohol, reported that the environment of the accommodation provided motivation to “changing their lives for the better”. Service users reported that the service providers would arrange for group sessions in common spaces of the hotel to encourage people to talk about their struggles. Talking about the peer support in the accommodation, someone said: “We were sitting around, just seven, eight people, recovering alcoholics. That was a big boost for me. I was seeing a stranger just opening up and really devoted to leaving alcohol alone. That just made me push through.” (SU1, South West)